Endocrine Abstracts

JOINT3827

Introduction: Pregnant women with type 1 diabetes face an increased risk of maternal and neonatal complications. While tight glycemic control is beneficial in reducing these risks, it can also increase the risk of hypoglycemia, leading to recurrent episodes and potentially severe hypoglycemia, which may culminate in an excessive and pathological fear of hypoglycemia

Objective: This study aims to assess the link between severe hypoglycemia and pathological fear of hypoglycemia in pregnant women with type 1 diabetes, considering factors like diabetes characteristics and mental health.

Methods: A prospective study enrolled 70 pregnant women with type 1 diabetes between March 2022 and December 2024. Fear of hypoglycemia was assessed using the HFS-II scale. Severe hypoglycemia was defined as an event requiring assistance due to altered mental or physical status, regardless of blood glucose level. Data analysis was performed using Tibco Spotfire, with Chi-square tests for categorical variables and Kruskal-Wallis tests for numerical and categorical comparisons.

Results: The frequency of severe hypoglycemia was 47 %, and the mean HFS II score was 31 in this group (G1). In the second group (G2), 53 % of patients had no episodes of severe hypoglycemia, and the mean HFS II score was 7. Group 1 demonstrated poorer glycemic control, evidenced by a higher frequency of severe hypoglycemia, lower hypoglycemia awareness, and higher HbA1c levels. This group also exhibited a higher prevalence of diabetes-related complications, including retinopathy and nephropathy. Furthermore, Group 1 demonstrated less SMBG and fewer adjustments to their diabetes management regimen. In contrast, Group 2 exhibited better glycemic control, lower complication rates, and improved self-care practices. Potential contributing factors are the longer duration of diabetes and the presence of autoimmune diseases in Group 1. The factors that were found to be significantly correlated with a high HFSII score were anxiety (P = 0.0007), depression (P = 0.0009), the perception of receiving inadequate care and emotional support (P = 0.0065), and the presence of diabetic retinopathy (P = 0.005). Severe hypoglycemia was associated with anxiety (P = 0.0009), depression (P = 0.0006), perceived inadequate care and support (P = 0.0011), recurrent hypoglycemia (P = 0.0001), hypoglycemia unawareness (P = 0.0001), poor glycemic control (P = 0.0008), and diabetic retinopathy (P = 0.034). Lipodystrophy areas demonstrated a strong association, although it did not reach statistical significance (P = 0.0672).

Conclusion: Severe hypoglycemia affected 47 % of pregnant women with type 1 diabetes, raising concerns due to its association with fear of hypoglycemia and its link to factors like anxiety and inadequate care.